Provider Demographics
NPI:1063854362
Name:MCLEAN, PETER S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 KENDUSKEAG AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3209
Mailing Address - Country:US
Mailing Address - Phone:207-702-3778
Mailing Address - Fax:
Practice Address - Street 1:188 SPRING ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1529
Practice Address - Country:US
Practice Address - Phone:207-924-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist